Showing papers by "Parikshit S. Sharma published in 2022"

Left bundle branch area pacing in patients with heart failure and right bundle branch block: Results from International LBBAP Collaborative-Study Group

Abstract: BackgroundCardiac resynchronization therapy (CRT) using biventricular pacing has limited efficacy in patients with heart failure (HF) and right bundle branch block (RBBB). Left bundle branch area pacing (LBBAP) is a novel physiologic pacing option.ObjectiveThe aim of the study was to assess the feasibility and outcomes of LBBAP in HF patients with RBBB and reduced left ventricular systolic function, and indication for CRT or ventricular pacing.MethodsLBBAP was attempted in patients with left ventricular ejection fraction (LVEF) <50%, RBBB, HF, and indications for CRT or ventricular pacing. Procedural, pacing, and electrocardiographic parameters; clinical response (no HF hospitalization and improvement in NYHA class); and echocardiographic response (≥5% increase in ejection fraction) to LBBAP were assessed.ResultsLBBAP was attempted in 121 patients and successful in 107 (88%). Patient characteristics included age 74 ± 12 years, female 25%, ischemic cardiomyopathy 49%, and ejection fraction 35% ± 9%. QRS axis at baseline was normal in 24%, left axis 63%, right axis 13%. LBBAP threshold and R-wave amplitudes were 0.8 ± 0.3 V @ 0.5 ms and 10 ± 9 mV at implant and remained stable during mean follow-up of 13 ± 8 months. LBBAP resulted in narrowing of QRS duration (156 ± 20 ms to 150 ± 24 ms (P = .01) with R-wave peak times in V6 of 85 ± 16 ms. LVEF improved from 35% ± 9% to 43% ± 12% (P < .01). Clinical and echocardiographic response was observed in 60% and 61% of patients, respectively. Female sex and reduction in QRS duration with LBBAP were predictive of echocardiographic response and super-response.ConclusionLBBAP is a feasible alternative to deliver CRT or physiologic ventricular pacing in patients with RBBB, HF, and LV dysfunction. Cardiac resynchronization therapy (CRT) using biventricular pacing has limited efficacy in patients with heart failure (HF) and right bundle branch block (RBBB). Left bundle branch area pacing (LBBAP) is a novel physiologic pacing option. The aim of the study was to assess the feasibility and outcomes of LBBAP in HF patients with RBBB and reduced left ventricular systolic function, and indication for CRT or ventricular pacing. LBBAP was attempted in patients with left ventricular ejection fraction (LVEF) <50%, RBBB, HF, and indications for CRT or ventricular pacing. Procedural, pacing, and electrocardiographic parameters; clinical response (no HF hospitalization and improvement in NYHA class); and echocardiographic response (≥5% increase in ejection fraction) to LBBAP were assessed. LBBAP was attempted in 121 patients and successful in 107 (88%). Patient characteristics included age 74 ± 12 years, female 25%, ischemic cardiomyopathy 49%, and ejection fraction 35% ± 9%. QRS axis at baseline was normal in 24%, left axis 63%, right axis 13%. LBBAP threshold and R-wave amplitudes were 0.8 ± 0.3 V @ 0.5 ms and 10 ± 9 mV at implant and remained stable during mean follow-up of 13 ± 8 months. LBBAP resulted in narrowing of QRS duration (156 ± 20 ms to 150 ± 24 ms (P = .01) with R-wave peak times in V6 of 85 ± 16 ms. LVEF improved from 35% ± 9% to 43% ± 12% (P < .01). Clinical and echocardiographic response was observed in 60% and 61% of patients, respectively. Female sex and reduction in QRS duration with LBBAP were predictive of echocardiographic response and super-response. LBBAP is a feasible alternative to deliver CRT or physiologic ventricular pacing in patients with RBBB, HF, and LV dysfunction.

Comparison of ablation index versus time‐guided radiofrequency energy dosing using normal and half‐normal saline irrigation in a porcine left ventricular model

Abstract: Ablation Index (AI) is a multiparametric quality marker to assess the durability of radiofrequency (RF) lesions. The comparative effectiveness and safety of AI versus time‐based energy dosing for ablation of ventricular arrhythmias are unknown.

Advances in Cardiac Electrophysiology.

Abstract: Despite the global COVID-19 pandemic, during the past 2 years, there have been numerous advances in our understanding of arrhythmia mechanisms and diagnosis and in new therapies. We increased our understanding of risk factors and mechanisms of atrial arrhythmias, the prediction of atrial arrhythmias, response to treatment, and outcomes using machine learning and artificial intelligence. There have been new technologies and techniques for atrial fibrillation ablation, including pulsed field ablation. There have been new randomized trials in atrial fibrillation ablation, giving insight about rhythm control, and long-term outcomes. There have been advances in our understanding of treatment of inherited disorders such as catecholaminergic polymorphic ventricular tachycardia. We have gained new insights into the recurrence of ventricular arrhythmias in the setting of various conditions such as myocarditis and inherited cardiomyopathic disorders. Novel computational approaches may help predict occurrence of ventricular arrhythmias and localize arrhythmias to guide ablation. There are further advances in our understanding of noninvasive radiotherapy. We have increased our understanding of the role of His bundle pacing and left bundle branch area pacing to maintain synchronous ventricular activation. There have also been significant advances in the defibrillators, cardiac resynchronization therapy, remote monitoring, and infection prevention. There have been advances in our understanding of the pathways and mechanisms involved in atrial and ventricular arrhythmogenesis.

Comparison of radiofrequency ablation from the coronary cusps and endocardial left ventricular outflow tract for left ventricular summit ventricular arrhythmias in a porcine and infrared thermal model

Abstract: The coronary cusps (CCs) are utilized as an alternative vantage point for radiofrequency catheter ablation (RFCA) of left ventricular summit ventricular arrhythmias but are sometimes a challenge despite favorable activation timing and pace mapping.

Feasibility and safety of laser balloon pulmonary vein isolation in patients with prior left atrial appendage occlusion device implantation

Abstract: With the increasing adoption of left atrial appendage occlusion (LAAO) procedures and the eligibility of patients for pulmonary vein isolation (PVI) post device placement, we examined the feasibility and safety of laser balloon (LB) for PVI in patients with prior LAAO.

Abstract 9547: Demographic Differences in Patients With Frequent PVCs and Cardiomyopathy in the General Population Receiving Ambulatory Holter Monitoring

Abstract: Introduction: A high burden of premature ventricular contractions (PVCs) has been associated with the development of cardiomyopathy (CM) and heart failure. However, the prevalence of high PVC burden and cardiomyopathy (CM) remain unclear. Hypothesis: The prevalence of high PVC burden (>5%) is underestimated in patients receiving Holter monitors and those with CM (LVEF <50%). Methods: A prospective multicenter clinical study of consecutive patients undergoing ambulatory Holter monitors (24 hours up to 2-weeks), between July 2018 through June 2020 were reviewed. Demographic data, PVC burden and LV function were collected within 6 months of Holter placement. Results: A total of 8 centers across the US provided a total of 6,808 patients with ambulatory Holter monitors. Four and 5% of patients undergoing Holter monitors had a PVC burden of 6-10% and >10%, respectively. A total of 3,938 patients had assessment of LVEF within 6 months of Holter, of which 634 (16%) had CM and 173 (4%) had both CM and PVCs > 5%. Males were more likely to have had LVEF assessment than females (58% vs. 55%, P=0.013). Table summarizes demographics in the overall population based on PVC burden and presence of CM. High PVC burden (>5%) was more prevalent in older, male, and White patients. In an ordinal logistic regression to assess PVC burden with gender separately for LVEF < or > 50%, females were found to have a higher PVC burden in the population with preserved LVEF (OR=1.59, 95% CI: 1.13, 2.22) but not with CM (LVEF < 50%, OR=1.13, 95% CI=0.97, 1.32). Females had a lower prevalence of high PVC burden (>5%) than males (7% vs. 11%; p<0.001), including among those with CM (23% vs. 29%, p=0.1). Conclusions: High PVC burden and CM are quite prevalent in the population undergoing Holter monitors. Older age is associated with higher PVC burden but no age difference is present between different PVC burdens in patients with CM. Females have a lower prevalence of high PVC burden (>5%) and combined high PVC burden and CM than males.

Abstract 15346: Outcomes of Conduction System Pacing in Patients With Cancer and Cardiomyopathy

Abstract: Introduction: Conduction System (His-Bundle, Left Bundle Branch) Pacing (CSP) for cardiac resynchronization therapy (CRT) provides more physiologic ventricular activation than right ventricular pacing. CSP has demonstrated improved outcomes in patients with cardiomyopathy. The effectiveness of CSP in patients with cancer or prior exposure to cardiotoxic agents is unknown. Methods: We retrospectively studied patients with cancer who underwent CSP for CRT from January 2018 to June 2021 at Rush University Medical Center. Changes in QRS duration, left ventricular ejection fraction (LVEF), B natriuretic peptide (BNP), and hospital admission rates pre- and post-initiating CSP were analyzed at baseline compared with one-year post CSP using student’s T-Tests. Results: Sixty-five patients with cancer underwent CSP, of which 11 had cardiomyopathy and underwent CSP for CRT. Five patients (45.5%) were female, 5 (45.5%) Caucasian, with mean age 71.2± 9.0 years. Non-Hodgkin Lymphoma (3 cases, 27.3%) was the most common cancer. Most (90.1%) patients had non-metastatic disease, 72.7% had prior chemotherapy, 54.5% were treated with cardiotoxic agents. Seven patients (63%) had a baseline left bundle branch block (LBBB). QRS duration shortened (122.3 ± 18.9 ms. vs. 153.7 ± 20.6 ms, p=0.003), LVEF increased (27.0 ± 6.2% vs. 39.0 ± 12.9 %, p=0.007), and BNP decreased (807.6 ± 1709.9 pg/ml vs. 591.4.0 ± 1079.4 pg/ml, p=0.78) (figure1). There was no change in heart failure hospitalizations (0.3 ± 0.48 admissions /person/year), at baseline vs. 1-year post-CSP. Conclusion: In this small population of patients with cancer and reduced LVEF with indications for CRT, CSP was associated with significant improvement in LVEF and QRS duration; and a non-significant decrease in BNP. The overall hospitalization rate was very low. Future studies in a larger population with a longer follow-up period are paramount to further assess this promising strategy.

Case report: diagnosis of chronic Chagas cardiomyopathy using a multimodality imaging approach

Abstract: Abstract Background In the USA, ∼300 000 people are affected by Chagas heart disease, a growing, but commonly overlooked, public health issue. Chagas as a potential aetiology of dilated cardiomyopathy remains under-recognized. We present a case where multimodality imaging was essential in the diagnosis and management of Chagas heart disease. Case summary A 54-year-old man, originally from Mexico, presented to the emergency department with chest pain and recurrent syncopal episodes, found to be in haemodynamically unstable ventricular tachycardia (VT) requiring urgent cardioversion. Urgent coronary angiography revealed no obstructive disease. A transthoracic echocardiogram revealed moderately reduced left ventricular systolic function (left ventricular ejection fraction 35–40%) with apical akinesis and an aneurysm of the apical septum. Cardiac magnetic resonance (CMR) confirmed a prominent apical aneurysm with dyskinesis of the apical septum, with the evidence of transmural myocardial late gadolinium enhancement of the entire left ventricular apex and a small apical thrombus. Serologic testing was positive for Trypanosoma cruzi IgG antibody, which was confirmed on repeat testing at the Centers for Disease Control and Prevention. Patient underwent VT ablation and was discharged on guideline-directed medical therapy including a regimen of anticoagulation, beta-blocker, and angiotensin-converting enzyme inhibitor therapies. He has had no subsequent syncope or VT. Discussion Chagas heart disease remains under-recognized and under-diagnosed despite the growing burden of T. cruzi infection in the USA. Suspicion for Chagas heart disease should be considered in patients presenting with heart failure symptoms and ventricular arrhythmias with the right corresponding history and imaging findings on echocardiogram and CMR.